“It Is Not About Us and Them”: Nursing Students’ Perception of Interdisciplinary Collaboration in Mental Health Clinical Studies

Abstract

Through interdisciplinary collaboration, a synthesis can be made together across subject boundaries that basically separate the subjects. This means that in addition to their own expertise, the professions can create a new understanding, new attitudes and new knowledge. In other words, a shared additional knowledge. The purpose of this study was to explore and describe nursing students’ experiences of interdisciplinary collaboration in clinical studies in mental health services. A qualitative, explorative study was performed based on three focus group interviews. A qualitative content analysis was conducted. The analysis resulted in the categories: ‘Community’—The students experienced the interaction and the communication in different ways. ‘Learning’—The students could gain both knowledge and understanding. In conclusion when the interdisciplinary collaboration was optimal, the students experienced it as enriching both in terms of interaction, communication, learning and understanding. Interdisciplinary collaboration can give students knowledge of cultural forms of expression so that they can better meet patients’ needs. The students also gain an increased understanding related to care. Students can get good learning opportunities when different professions are taught together.

Introduction

Patients in the mental health services often need support and help from several services and different professions. Over the years, developing interdisciplinary collaboration between the professions has not only become a political goal, but also a goal for developing students’ attitudes, understanding, communication and knowledge (Lingard, 2012). Different professions have different points of view arising from their education and occupation, as well as different ways of thinking and assessment that result in different actions and measures toward patients. It is important that the professions know each other’s mode of thinking in order to be able to provide comprehensive and optimal health care (Brandt et al., 2014; Elwyn et al., 2012). Cross-professional collaboration skills give them knowledge about the various forms of cultural expression. With a view to meeting the staffing needs of the future and providing effective health care, it is also absolutely necessary to collaborate across professions (Frenk et al., 2010).

The health and care service has been challenged to establish new forms of collaboration entailing innovation and improvement, and professionals in the health services are increasingly encouraged to collaborate (Schot et al., 2020). Interdisciplinarity and diversity of perspectives will thus be important to help patients. Such collaboration increases the quality of the care provided. Mutual recognition of interprofessional knowledge and competence is the prerequisite for a successful collaboration (Blacker & Deveau, 2010; McCloughen et al., 2011). The collaboration includes everything from communication and professional relationships to a variety of interdisciplinary forms of learning. Students’ meet many different professions in both the municipal health service and the specialist health service.

The focus of this study is nursing students’ experiences of interdisciplinary collaboration in clinical studies in mental health. In Norway, health services for people suffering from mental illness are divided into two administrative levels: municipality mental health services and specialized mental health services where the municipalities are the main provider and thus play a core role in the provision and coordination of these services. The municipal health service must provide necessary health and care services to everyone in the municipality at all times. The specialist health service includes health services that require specialist expertise.

Background

Interdisciplinary collaboration is generally well established in mental health care, and staff have different approaches to problems. One focus in mental health has been to replace hierarchical conditions with interdisciplinary collaboration, user involvement and user participation. In addition to communication and learning, collaboration also includes sharing, teamwork and respect. When students work together it leads to reflection on interdisciplinary collaboration (Chen et al., 2022). The merging of ideas broadens to develop innovative and culturally appropriate health-interventions (Morley & Cashell, 2017). In an interdisciplinary collaboration, it is vital that the different professions know each other’s functions. Patients’ needs and participation must be put at the center. When healthcare professionals understand each other’s roles and are able to communicate and work effectively together, patients are more likely to receive safe, quality care (Barnsteiner et al., 2007).

Some of the challenges are that interdisciplinary collaboration is perceived as making an extra effort and not as a form of work, and that healthcare personnel view concepts differently in accordance with their profession. Different requirements in terms of efficiency and results can be perceived as challenging and inhibiting in the collaboration (Olsen et al., 2015). When it comes to nursing students, the traditional competence model of “feeding” students with knowledge has been replaced by education based largely on critical reflection. Preceptors in mental health care are concerned about the nursing students will and ability to reflect on and exercise knowledge for managing the student role (Kirkbakk-Fjær et al., 2015).

In an interprofessional interaction with reflection based on knowledge and competence, it becomes important to clarify the roles of the various professional groups, and to facilitate their interaction. Teamwork with joint/shared decision-making fosters a synergistic impact on knowledge and skills (Bridges et al., 2011). Knowledge and skills from different professions influence each other in the direction of innovation competence, new patterns and creative solutions (Watzlawick & Weakland, 1984). Interdisciplinary reflection develops, and innovation competence can give patients safe, quality-based care and treatment (Barnsteiner et al., 2007; Laing & Bacevice, 2013). In an interdisciplinary context that the participants understand, opinions are formed, and decisions made. This becomes an interdisciplinary constructive, meaningful and reflective cycle (Weick, 1995).

A previous study of newly qualified nurses found that they experienced insecurity in collaboration with various professions, and that they knew too little about the roles and work tasks of other professions (Furunes & Brataas, 2014). Walker et al. (2019) found that nursing students’ believed that learning with other occupational groups would help them become more effective members of the health care system. Priest et al. (2008) examined the nurses interprofessional attitudes that arise from shared learning in mental health, reporting an increase clarity in understanding of their role, and how to collaborate, however they found no significant change in professional identity.

Williamson et al. (2020) evaluated the implementation of collaborative learning in clinical studies in nursing and midwifery education throughout the South West of England, and found that it was an advantage that several professions was represented in the supervision of students. Defenbaugh and Chikotas (2016) found that collaboration with someone who is an expert in communication increases awareness of communication in the meeting between nurses and patients in clinical settings. Cooperation between healthcare professionals is, therefore, important for creating efficient, safe, and good patient care.

Nursing education in Norway begins with a bachelor’s programme that consists of a sequence of theoretical modules, practical clinical skills training in academia and clinical studies. Our study is intended as part of the development towards a greater integration of interdisciplinary learning and collaboration in nursing education. In the long term, this can enhance the quality of nursing and meet the competence needs of the future. Moreover, it contributes to knowledge-based practice and boosts patient safety. Our study is primarily intended to uncover and describe nursing students’ experiences of interdisciplinary collaboration in clinical studies in mental health. Knowledge of the students’ experiences is important when interdisciplinary collaborative learning is to be implemented (Dolva et al., 2017).

Information about the students’ experiences with interdisciplinary collaboration in clinical studies can provide knowledge of what competence the students need in preparation before their clinical practice. In addition, it can help identify the areas within interdisciplinary collaboration that are important to emphasize in teaching and supervision.

The purpose of this study was to explore and describe nursing students’ experiences of interdisciplinary collaboration in clinical studies in mental health.

Method

The study had a qualitative, exploratory and descriptive design (Polit & Beck, 2021).

It was necessary to start with an exploratory approach (Calder, 1977), since there was little prior knowledge of how nursing students experienced interdisciplinary collaboration in mental health care. Focus group interviews were used and analyzed by using inductive content analysis (Graneheim & Lundman, 2004). The researchers were all faculty employees and part of the qualitative research process and included an assistant professor, a senior lecturer, and a PhD associate professor. They had no prior relationships with the students included in this study.

Setting and participants

All the students in this study were part-time students in their second and third years of the four-year bachelor’s degree in nursing. The students were taking part in clinical studies in mental health. Prior to their clinical studies, the students had a preparatory day with an interdisciplinary focus. This comprised a joint teaching session for two different bachelor-programmes at the university, during which the students worked together in groups with cases and found solutions together.

Lecturers at the faculty follow up and guide groups of students who are taking part in clinical studies. Three random groups with students were represented.

The participants were recruited by their teachers in connection with the clinical studies and with permission from the head of department. The informants were recruited by their teachers in connection with the clinical studies and with permission from the head of department.

Data collection

The study was conducted in the autumn of 2019 and the spring of 2020. A total of 34 students received oral and written information about the study. Of these, a total of 19 students agreed to participate—one man and 18 women. Fourteen of the participating students had a practice placement in the municipal health service and five in the specialist health service.

A total of three focus group interviews were conducted. One of the focus groups included only students who were in their clinical studies in municipal health service. In the other two groups, there were students from both specialist health services and the municipal health service. There were seven students in focus group one, six students in focus group two and six students in focus group three. The assistant professor led the three focus group interviews. The senior lecturer was a participant in the first interview and provided supplementary questions and comments. The PhD associate professor was a participant in the two last interviews and provided supplementary questions and comments in those interviews. Several of the students in the three focus groups had experience with interdisciplinary collaboration from work practice prior to their clinical studies in mental health. The members were registered when they attended the focus groups. The focus group interviews were recorded on tape and transcribed verbatim by the first author.

Analysis

A qualitative inductive content analysis inspired by Graneheim and Lundman (2004) was used to describe the nursing students’ experiences.

Step 1

All three authors read the transcribed interviews carefully several times to gain comprehensive understanding of the material and form an overall impression.

Step 2

The text was read again and all units of meaning were identified and marked.

The meaningful units (a compilation of words that relate to the same opinion) were then identified in accordance with the purpose of the study.

Step 3

The third step was condensation (shorten the meaning unit without losing the meaning content).

Step 4

In the fourth step the condensed meaningful units were grouped at a higher level, to abstract. Condensed and abstracted meaningful units were highlighted in an array before they were coded.

This fourth step result of the abstraction is named as a code. A code becomes a collective term for a group of meaning units or a “label.”

Step 5

The fifth step was to assess similarities and differences in codes. In this step there were larger rooms for interpretations and possible reformulations.

Step 6

Finally, further abstraction led to the subcategories and the categories (Groups of content that shared a community) (Graneheim & Lundman, 2004; Lindgren et al., 2020).

To secure the trustworthiness, the researches I.U., H.S.-K. and K.K.F. discussed the condensed meaning units, codes, subcategories, and categories throughout the analysis process until they reached consensus. The analysis revealed two categories and four sub-categories, presented in Table 1.

Table 1. The table shows the two categories (Community and Learning) and the four sub-categories (Interaction, Communication, Knowledge and Understanding) with interpretations.

Community The students experienced the interaction and the communication in different ways		Learning The students gained both knowledge and understanding
Interaction The quality of interaction varies with the setting/healthcare provider	Communication Communication across professions provides knowledge of each other's areas of expertise and gives a holistic view of the patient.	Knowledge Interdisciplinary knowledge gives good problem solving and a complete health service.	Understanding Understanding is based on interdisciplinary conversation

Ethical considerations

The study was approved by the Norwegian Centre for Research Data (NSD), Ref number: 494625. Ethical considerations and guidelines were applied with regard to confidentiality, integrity and voluntariness among the participants (World Medical Association, 2013). The researchers promoted contributions from everyone by giving each participant time to express themselves during the focus group interviews. The informants gave written informed consent to participate in the focus group interviews. The researchers interpreted the findings jointly to strengthen credibility and reliability.

Findings

The students’ experienced the interaction and the communication in different ways in the community

The quality of interaction varies with the healthcare providers

The students found that there were differences between the municipality and the specialist health service when it came to interdisciplinary collaboration. There was more interdisciplinary interaction in the specialist health service than in the municipal health service. According to the students, the municipal agencies worked side by side rather than collaborating in interdisciplinary interaction. They pointed out that patients who lived at home had a conversation once or twice a week with the psychiatric service in the municipality, but then it was community nursing service that dosed and delivered medication. ‘So right there, I can’t say that I feel interaction—in that we somehow interact with the same patient—we do not.’ ‘Although the work tasks are shared, there is no shared goal of helping the patient based on different approaches’ (1). It seemed to be the time available that controlled the division of work tasks between the community nursing service and the municipal mental health service. ‘The psychiatric service could have done both the tasks—but to get better time for something else, it somehow becomes the responsibility of the community nursing service’ (1). Students also experienced that the various services had little to do with each other and that they did not know each other’s work tasks. ‘… and then I think that there is also little cooperation’ (1). They experienced that the professions worked in “groups” for themselves (1). One student stated: ‘I work in the municipal health service in addition to my studies. I miss proper interdisciplinary collaboration there’ (3).

Those of the students who completed their clinical studies in the specialist health service experienced it differently. Many of them had interdisciplinary interaction with both patients and staff and interacted in interdisciplinary groups and teams with and without patients. Some students experienced interdisciplinary collaboration and collaboration when needed, while others took part in regular interdisciplinary meetings, and participated in democratic meetings across professions. They said, ‘It’s not about us and them—everyone talks about situations out loud for everyone—everyone is heard’ (1). Some students also found interdisciplinary collaboration across municipal agencies positive: ‘Very positive to be able to call and discuss matters with the psychiatric hospital—there is more competence’ (1, 3). Moreover, interdisciplinary collaboration across agencies could contribute to the utilization of each other’s expertise and it could be useful to collaborate beyond an agency or a department within mental health.

Communication across professions provided appropriate knowledge of other professions’ work tasks. Students felt it was important that different professions assessed patient situations.

‘You really see this when you are in a substance abuse institution—how important it is to have acquired knowledge from different professions’ (1). At substance abuse institutions, they took part in interdisciplinary meetings where patient situations were discussed. They found that therapists participated more often when they had an office at the institution. When all the therapists had an office at the substance abuse institution, the interdisciplinary collaboration was taken care of in a unique way in interdisciplinary teams. ‘Interdisciplinary collaboration down with us at the center is unique’ (1). They experienced the community and the socializing as a method in itself where knowledge could be shared, and everyone could talk to each other. The students found such interdisciplinary interaction with different professions very useful.

Communication across professions provides knowledge of each other’s areas of expertise and gives a holistic view of the patient

Often the different professions had different subject-related ideas that could benefit patients. Communication across professions provided more opportunities to discuss difficult topics, leading to better, more accurate and more thoughtful solutions to problems. ‘We have different backgrounds in different professions and different degrees of education so that we get a holistic view of cases’ (1, 2). The informants highlighted the importance of discussion and communication in the municipal health services. Furthermore, the various professions could contribute their professional identities in a way that fostered development while the students experienced good communication with the others in the interdisciplinary communities.

‘They are very good at talking to us—and communicating all the time during the day’ (1, 2). Students perceived that the various participants noted, confirmed, and observed behavior from the perspective of their own profession. They achieved good interdisciplinary contact with employees who they saw as dedicated to their own professions and subject areas. However, views differed on the extent to which they as students could participate in general discussion. While some asserted that: ‘Students can definitely participate’ (2, 3), others were more doubtful and believed that knowledge and understanding of the patients was a prerequisite for participation: ‘You can participate in our department if you have knowledge and understanding for the patients’, ‘…depends on how much you can contribute—must surely come up with something important’ (3). Participation was assessed against what they thought they could contribute. They experienced that they received “input” through interdisciplinary communication and found it: “useful with recognition across professions” (1). Moreover, they benefitted more from the clinical studies when they were part of the interdisciplinary communication, learning that the different professions could give each other recognition that was useful, and that the different professions had different communication focus. Psychiatrists had the most medical focus while social workers concentrated more on planning and living conditions. ‘The occupational therapist has responsibility for the relaxation exercises among other things’ (2). Nurses had a very great responsibility for contact with the patient: ‘The nurse could certainly fill in all the gaps’ (1). ‘The nursing process fits very well into the interdisciplinary collaboration’ (2). The students found that good relations with patients were not necessarily professionally dependent and that the different professions had different experiences and views. At the same time, care for others was something everyone brought with them.

However, it was difficult to separate the student role from the work role outside of studies. Several of the students had experience with interprofessional collaboration from work outside their studies. One student said: ‘Lots of interdisciplinary collaboration at the somatic hospital, … very used to communicating and being with all of them’ (1). According to one student: ‘Incredibly many people in the medical department have different educational backgrounds and experiences.’ If the students showed respect and humility, this could give them a stronger position and greater sense of security than if they did not consciously show such attitudes. It also emerged from the findings that some of the students did not think in advance that they would meet so many different professions in the community. Many felt that they were unprepared to work in an interdisciplinary setting and wished they had received more information about interdisciplinary collaboration before beginning their clinical studies. They specifically mentioned the need for more information about the roles of the various professions. Notably, they did not want long lectures on the topic but stories about the different roles and functions.

Learning –The students experienced that they could gain both knowledge and understanding

In the interdisciplinary collaboration, the students experienced interdisciplinary learning through both gaining new knowledge and better understanding.

Interdisciplinary knowledge gives good problem solving and a complete health service

The students found that knowledge could be shared across the professions and provide increased competence. Such a knowledge sharing could provide optimal problem solving and “a complete health service”. Supervision could go across the professions, which means that they could learn and acquire knowledge from different professions. The students sought guidance and advice from everyone in the interdisciplinary collaboration, contacting the various professions as needed. Moreover, they became familiar with the work tasks of other professions during supervision and discovered that there was no high threshold for using other professions. ‘We use everyone for what they are worth’ (1). In addition to the regular weekly tutoring that involved all staff, they learned through interprofessional discussion, finding that there was a lot of room to share knowledge and expertise. ‘Sharing knowledge across professions provides a holistic view and better problem solving’ (2). They also noted that treatment plans were constantly evaluated and that patients received very good follow-up. The different professions supported each other and encouraged each other. ‘We are building a complete health service together’ (2).

Understanding is based on interdisciplinary conversation

The students experienced learning and increased knowledge, gaining a new, changed and expanded understanding. This applied to increased ethical understanding in particular: ‘You gain increased ethical understanding through interdisciplinary collaboration with different educational professions and levels of education.’ ‘It’s important to talk together’, and ‘Not everyone has the same good attitudes’ (1) were some of the reflections they expressed, and which they viewed in the context of increased ethical understanding through interdisciplinary learning. It was possible to discuss and contradict each other and this could lead to increased knowledge and understanding. Their beliefs and opinions were tested through discussion and counter-argumentation, while others’ beliefs and opinions were respected, and good collaboration spread to patients. The interdisciplinary collaboration meant that they gained respect for other professional roles “across and up and down” (1). The nurse role was perceived as strong in the collaboration. The students learned and gained insight into other professions’ work tasks also during supervision, and this included asking questions: ‘It is instructive to gain knowledge from the profession of others.’ ‘I learned a lot from being with a social worker’ (1). The thoughts of those in the different professions varied according to their competencies: ‘It is interesting to see what the different professions are interested in and what they ask about.’ There were differences in power based on competence level, and the students perceived that those with the highest educational competence exercised the most power.

Several of the students wished there was more interdisciplinary and interprofessional focus in practice and thought that they learned more from those with different backgrounds.

Discussion

The purpose of the study was to explore and describe nursing students’ experiences of interdisciplinary collaboration in clinical studies in mental health.

The students perceived differences when it came to interaction and communication in the interdisciplinary community

The students perceived differences between the municipality and the specialist health service. In the municipality, there was more division of labor than collaboration. Time was of the essence when it came to the distribution of tasks between municipal agencies. In order for different competencies and professions to function in a collaboration, it is important to clarify the individual primary tasks, define each individual’s role and have a clear division of tasks (Willumsen & Ødegård, 2016). A good dynamic interaction between professions and between municipal agencies thus presupposes that they know each other’s area of competence and services well. A dynamic process that takes time. It is a matter of recognizing contributions from different professions and services, while at the same time integrating these in relation to the users’ needs. The findings in our study may indicate that the collaboration processes do not represent an optimally integrated joint competence between the municipal agencies. The challenge will be to develop the collaboration process both between agencies and between professions in order to create good interdisciplinary collaboration in the municipalities, which will also provide an efficiency gain (Willumsen & Ødegård, 2016). Students found that time was all-important when it came to the distribution of work tasks between the agencies. Therefore, it is important that there is a good balance of shared contributions in the collaboration process—a balance that also includes solutions and conflicts. If the different contributions are too similar so that the collaboration process becomes weak, or so different that it becomes difficult to integrate them, then the collaboration can break down (Lawrence & Lorsch, 1967; Willumsen, 2008). The students in the specialist health service experienced more variants of interdisciplinary collaboration and community than the students in the municipal mental health service. In the meetings of the specialist health service, everyone took part on an equal footing, and everyone was heard because it was an interdisciplinary forum for discussion and establishing relationships. The students distinguished between meetings with patients, and meetings where employees only were represented. In addition, meetings where plans were made, and measures discussed with or for patients also took place. They described an interdisciplinary collaboration process with contributions from the core competence of various professional groups. Such a process balances dynamically between different contributions and tasks, and requires everyone’s efforts (Wei et al., 2020). As Beasley-Murray (2000) and Reeves and Hean (2013) describe, the students could build their interprofessional identity and their social or symbolic capital in various professional communities. The interdisciplinary theoretical approaches support them in the design and evaluation of interprofessional activities.

Wei et al. (2020) describe how the interdisciplinary care culture can be nurtured through five processes: building care relationships, developing an owner mentality, giving constructive feedback, exercising a strengthened practice and acting as the first and last line of defense. A study by Weller et al. (2011) dealing with the collaboration between doctors and nurses in a hospital environment pointed out that sharing information and agreeing on goals wereconsidered the basis for good decision-making. Maintaining an environment where open communication can take place becomes important for patient safety. Respect and adaptability become essential. It is also important to clarify role expectations in the interdisciplinary environment to avoid conflicts. The different professions will basically have different expectations of each other as partners (Bateman et al., 2003).

The students experienced learning and gained knowledge and expanded understanding in the interdisciplinary collaboration

The students in our study sought guidance and drew on the expertise of everyone in the interdisciplinary team for what it was worth, learning that they could derive benefit from all the other professions. Through discussing patient situations, they became familiar with the work tasks of different professions. Knowledge was shared and they achieved better problem solving through knowledge sharing. The importance of collaboration, discussion and reflection for learning and understanding is also brought out by other studies. Kirkbakk-Fjær et al. (2015) found that reflection became a tool to understand and develop nursing through abstraction grounded in knowledge. Mellor et al. (2013) found that students who participated in interprofessional education (IPE) programs gained a better understanding of professional roles while team dynamics increased their sense of being informed. The students in the IPE program experienced professional pride and they could put the activities in the context of the “real world”. Moreover, they recognized how the skills of interprofessional interaction could be used in future practice.

The students in our study found that quality in communication and relationships does not necessarily depend on profession, but more on quality, security, and trust in relation to the service recipient. They learned from each other as well as from supervision and became acquainted with other professions’ core competence. Mellor et al. (2013) found also that communication was the glue in the collaboration and that social support and the relaxed had no assessed environment that enabled students to engage without inhibition was a prerequisite for good collaboration.

Katzelnick and Williams (2015) conclude that learning collaboration is necessary for the rapid dissemination of effective, complex innovations which in turn influence effective team-based care.

The students in our study gained increased ethical understanding through interdisciplinary collaboration with various professions. Multidisciplinary viewpoints on the ethical issues gave them increased understanding. Ewashen et al. (2013) confirm that ethical interprofessional collaboration becomes particularly relevant and necessary when interprofessional practice decisions are contested. The collaboration can thus probably help to improve students attitude formation, theoretical knowledge and how to communicate with the patients and their families. Nursing teachers express a need for just improvement of students’ preparations within the themes of attitude formation, theoretical knowledge and non-instrumental skills (Kirkbakk-Fjær et al., 2015).

Furthermore, the students in our study perceived that differences in culture can probably affect the balance of power in interdisciplinary contexts, as well as different status in society.

Beyene et al. (2018) show that creating a culture of trust is based on applying guidelines in a person-centred way and standing together as a team. Shared Decision-Making with both patients and staff will be good for creating a culture of trust, which may enhance patient safety.

Another finding in our study was that the students experienced that it was difficult to separate the student role from the work role outside the studies.

Unexplained role expectations can lead to conflicts that can result in a struggle to take on work tasks or a struggle to get rid of work tasks due to great work pressure. It is therefore important to clarify the expectations of the various participants in the interdisciplinary collaboration. Additionally, our students found that the various professions in interdisciplinary collaboration satisfied the patient’s needs to a great extent, and that as students they were allowed to participate in most tasks.

The students in our study also conveyed that they had a preparatory day with joint teaching for two different bachelor programs prior to their clinical studies. They then worked together in groups with cases and found solutions together. Other studies prove that such learning collaborations where different professions or educations collaborate on solutions can provide unique collaborative learning.

Reeves and Hean (2013) show that the bilateral exchange of pedagogy across subject areas can provide enhanced quality, strengthen active learning across the professions and prepare students for collaborative interactions in clinical studies. One profession needs knowledge from the other. The coordinated efforts of the interdisciplinary team will prepare students for practice in a changing world. Interprofessional teamwork includes shared team identity, clarity, interdependence, integration, and shared responsibility. Brown (2009) shows that today, collaborative practice within an interdisciplinary health service environment is very important for the nursing profession. Non-participation in interdisciplinary educational initiatives will limit the opportunity to nurture the nursing discipline.

The students in our study found that they were unprepared to meet so many different professions in the clinical studies in mental health. This highlights the importance of strengthening and prioritizing interdisciplinarity in teaching and research contexts. Implementation of interdisciplinarity in education and in clinical studies is a social responsibility. The students wanted more information about the roles of interdisciplinary professions, and they perceived that those with the highest educational competence exercised the most power.

Lindqvist et al. (2019) said that true cooperation becomes more important than competition. The real competition lies in the challenges you face together with service users, different professions, students, and teachers both across settings and national borders.

The students in our study wanted more information about the roles of interdisciplinary professions and they did not want long lectures on the topic but stories about the different roles and functions. If they became familiar with other concepts and content that interdisciplinary collaboration contains, they would probably also have a different perspective for their wishes for teaching in the topic. It could be concepts such as “collaborate care”, “cross professional” and “joint working” that are covered in interprofessional education (Willumsen & Ødegård, 2016). Future studies should also explore the user perspective on whether more interdisciplinary collaboration improves users’ experience of care. A key challenge appears also to be whether interprofessional learning is “worth the fight”, that emphasizes the need for strong leadership to align pedagogical approaches in education and practice (Lindqvist et al., 2019). Further research is needed related to partners, including staff and students, also in terms of patient care methods (Williamson et al., 2020). There is also a need for leaders to become more involved in creating a culture of interaction (Schot et al., 2020). More research is needed on how interdisciplinary collaboration improves the population’s health, reduces health costs, improves the quality of care and patients’ experience of care they receive (Brandt et al., 2014).

Methodological considerations

The study was conducted in a Norwegian context, and generalizability must be interpreted with caution since nursing education may differ across countries, and the selection of informants was limited (19 students). However, this study may give a picture of the student’s experiences of interdisciplinary collaboration in clinical studies in mental health. Two lecturers who followed up with the student in their clinical practice asked the students verbally and in writing to participate. The informed consent specified that it was voluntary for the student to participate in the study and that there were no consequences if they declined participation.

A potential limitation is a need for more information about the participants’ previous experiences with interdisciplinary work, which may have influenced the findings. Therefore, follow-up questions were used to ensure the students shared their experiences with interdisciplinary practice linked to this clinical practice. Three researchers (I.U., H.S.-K., and K.K.F.) were involved in the analytic process. Every step in the analysis was discussed to enhance trustworthiness (Graneheim et al., 2017).

All steps in this research process and analysis are described, and the results are illustrated by quotes so that others can also evaluate their transferability (Polit & Beck, 2021). The findings may provide valuable information and new knowledge to nursing science by showing the importance of interdisciplinary collaboration in nursing education. Moreover, we recommend mapping and adapting curriculum literature in nursing education to promote and strengthen the learning outcomes within an interdisciplinary collaboration. Furthermore, the interaction and cooperation between the various Bachelor programmes should be maintained to promote interprofessional collaborative practice experiences for the students.

Exploring student-written work to support the interpretation of findings can be a recommendation for future research strategies.

Conclusion

In the municipal health service, the students experienced more side by side working than collaboration with ­interaction. They experienced time as a decisive factor that ­governed the division of labour between agencies. In the specialist health service, they experienced a community with more relationships, discussion, reflection and knowledge exchange. When interdisciplinary collaboration worked optimally, students found this enriching—enriching both in terms of interaction and communication in the community, and in terms of knowledge exchange and understanding through interdisciplinary learning.

It will be important to facilitate increased interprofessional collaboration competence in education, both in preparations for the clinical studies and during them. Moreover, it is vital to create learning outcomes for students that can provide personal and social capital in the interdisciplinary collaboration. In an interdisciplinary community, the various actors can enhance their interprofessional cultural capital based on knowledge and skills that can increasingly meet the needs of service recipients and patients.

Ethical approval

Approval was given by the Data Protection Official (NSD), Ref. 494625.

Authorship

Study design: I.U., K.K.F., and H.S.-K.; data collection: I.U., K.K.F., and H.S.-K.; analysis: I.U., K.K.F., and H.S.-K., manuscript preparation: I.U. and H.S.-K. All authors have seen this last version and agreed upon it.

Disclosure statement

The authors report no conflict of interest, as the authors alone are responsible for the content and writing of this paper.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.