The role of the lecturer practitioner: An exploration of the stakeholders and practitioners perspective

Designing, Implementing, and Evaluating a Practice Tutor Internship Model during an Acute Care Clinical Internship

Purpose: The purpose of this study was to implement and evaluate a novel internship model that incorporates a practice tutor in physiotherapy clinical education during an acute care cardiorespiratory internship at a large acute tertiary care teaching hospital in Canada. Method: A prospective evaluation of this model was conducted by means of a mixed-methods approach using surveys and focus groups. The participants were students and clinical instructors (CIs) who were taking part in the internship. Results: Half of the CIs agreed that the practice tutor model gave them more time to manage their caseload and work with the student than did the traditional model, and 63% would recommend the model for future internships. In reviewing the focus group and open-ended data, we identified four themes: benefits, tensions, critical logistics, and unforeseen blind spots. There was a trend for patient attendance to increase with the practice tutor model compared with the previous year's internship session and with the 5 weeks immediately preceding the internship. Conclusions: On the basis of CIs' and students' self-reports, the piloted practice tutor model was perceived to facilitate students' clinical reasoning and collaborative learning skills. In addition, during the 5-week internship, the number of patients seen each day by the individual CIs and their students was not reduced, with a trend toward increased patient attendance. There was also a trend toward CIs having the same or more time to manage their caseload and work with the students compared with a non-practice tutor internship model. Recommendations to improve this model in future implementations are made.

Emergency nurses' perceptions of sedation management practices for critically ill intubated patients: a qualitative study

AIMS AND OBJECTIVES

The aim of this study was to explore factors influencing practices in assessing, titrating and managing sedation for the critically ill intubated patients, from the perspective of emergency nurses.

BACKGROUND

The number of critically ill patients presenting to Australian public Emergency Departments has increased by over 30% since 1980. Emergency nurses are increasingly relied upon to manage sedation of critically ill intubated patients. There is little evidence within international literature relating to how emergency nurses accomplish this.

DESIGN

Descriptive qualitative study.

METHOD

A purposive sample of 15 experienced emergency nurses participated in semi-structured face-to-face interviews. Transcribed data were analysed using thematic analysis.

RESULTS

The qualitative analysis yielded five themes: becoming the resuscitation nurse; becoming confident as the resuscitation nurse; communicating about sedation; visual cues and the vanishing act. The safety and quality of sedation experienced by critically ill intubated patients in ED was the responsibility of emergency nurses, yet uncertainties and barriers were evident.

CONCLUSION

Patient continuity of care, including optimisation of comfort relies upon the knowledge, skills and expertise of the emergency nurse allocated to the resuscitation area. For most nurses transitioning into the resuscitation nurse role, it represents the first time they will have had contact with patients with highly complex needs and sedation. The use of self-directed clinical workbooks and supervised clinical practice alone may be insufficient to adequately prepare nurses for the spectrum of critically ill sedated patients managed in the resuscitation area; a situation made worse in the presence of poor team communication.

RELEVANCE TO CLINICAL PRACTICE

The findings of this study should assist in the development of policy and formal education of emergency nurses transitioning into the resuscitation area and the management of continuous intravenous sedation to critically ill mechanically ventilated patients is required.

Assessing, monitoring and managing continuous intravenous sedation for critically ill adult patients and implications for emergency nursing practice: A systematic literature review

BACKGROUND

Critically ill mechanically ventilated patients in ED have complex needs; chief among these is adequate sedation in addition to effective pain-relief. Emergency nurses are increasingly responsible sedation and analgesia for this complex cohort of patients. The aim of this review was to examine (1) the evidence around assessing, monitoring and managing continuous intravenous sedation for critically ill adult patients, and (2) the implications for emergency nursing practice.

STUDY DESIGN

Systematic review.

METHOD

The review of literature extended from 1946 to 2013 and examined peer review journal articles, policy and guidelines to provide a more complex understanding of a phenomenon of concern. A total of 98 articles were incorporated and comprehensively examined.

RESULTS

Analysis of the literature identified several implications for emergency nursing practice and the management of continuous intravenous sedation: workload, education, monitoring and assessing sedation and policy.

CONCLUSION

Limited literature was found that directly addressed Australasian emergency nursing practices' in managing on-going intravenous sedation and analgesia for patients. Balancing patient sedation and analgesia requires highly complex knowledge, skills and expertise; the degree of education and training required is above that obtained during pre-registration nurse training. No state or national models of education or training were identified to support ED nurses' practices in managing sedation. Little research has addressed the safety of continuous sedation use in ED.

The competence and the cooperation of nurse educators

BACKGROUND

The competence of nurse educators and cooperation between nurse educators and nurse leaders and mentors are important in terms of producing high-quality and evidence-based nursing education.

OBJECTIVES

The purpose of this study was to assess the competence of nurse educators based on their own evaluations as well as those of nursing students, educational administrators, nurse leaders and nurse mentors and to describe the cooperation between educators and educational administrators, nurse leaders and nurse mentors.

DESIGN

A descriptive, cross-sectional survey design was used.

SETTING

The research was conducted in educational and clinical nursing settings.

PARTICIPANTS

The nurse educators, students and educational administrators were from polytechnics offering degree programs in nursing, public health nursing, emergency nursing and midwifery. The nurse leaders represented special health care and primary health care. The nurse mentors were nurses working in the medical wards of the university hospitals.

METHODS

The data were collected via email using a structured questionnaire (A Tool for Evaluation of Requirements of Nurse Teacher).

RESULTS

In total 689 responses were received from nurse educators (n=342), nursing students (n=202), educational administrators (n=17), nurse leaders (n=64) and nurse mentors (n=64). The results show that nurse educators rated their competence as being very good. Nursing students and nurse mentors were the most critical in their evaluations. The cooperation between nurse educators and educational administrators and nurse leaders was rated as good but nurse mentors were quite critical.

CONCLUSIONS

To maintain and improve the competence and cooperation of nurse educators, interventions are needed.

The role of the nurse teacher in clinical practice: an empirical study of Finnish student nurse experiences

This paper focuses on the role of the nurse teacher (NT) in supporting student nurse education in clinical practice. The paper draws on the outcomes of a study aimed at exploring student nurse experiences of the pedagogical relationship with NTs during their clinical placements. The participants (N=549) were student nurses studying on pre-registration nursing programmes in Finland. Data were analysed using descriptive statistics, cross-tabulation and ANOVA. The study showed that the core aspect of NTs work in clinical practice revolved around the relationship between student, mentor and NT. Higher levels of satisfaction were experienced in direct proportion to the number of meetings held between the student and NT. However, whilst the importance of this relationship has been reported elsewhere, an additional aspect of this relationship emerged in the data analysis. Those NT who facilitated good face to face contact also used other methods to enhance the relationship, particularly e-mail, virtual learning environment and texting. This outcome suggests that NT's interpersonal and communicative skills are as important as their clinical knowledge and skills in promoting effective learning in the clinical practice area. The paper argues for such approaches to be utilised within the emergent opportunities afforded by new communication and educational technologies.

The effectiveness of the lecturer practitioner role in clinical practice: an Irish perspective

BACKGROUND

Demands within academia such as teaching, publishing, research activity and generating grant income can make it difficult for nurse educators to protect time for clinical practice. In an effort to overcome this problem lecturer practitioner posts have been introduced with designated responsibilities in both clinical and educational settings.

METHODS

Using a mixed method descriptive methodology student nurses and registered nurses completed a modified questionnaire to examine the impact of lecturer practitioners (LPs) in clinical practice. Focus groups were also conducted with lecturer practitioners themselves.

RESULTS

The results identified that by having a clinical remit, LPs forged good relationships with student nurses and registered nurses in clinical practice, who considered the LP as being a learning resource with realistic expectations of the clinical environment.

DISCUSSION

The results provide further evidence to support the continuation of nurse educators in clinical practice for their own development, their students and registered nurses.

An overview of practice education models

Educating nursing students for entry level practice in complex health care settings is a concern in Canada and many other countries. National groups have called for improved practice education to better prepare students for actual practice. The purposes of this paper are identification and critical analysis of current practice education models. Ten basic model types were identified in the literature: faculty-supervised practicum, preceptorship, education unit, joint appointment, secondment, affiliate position, internship, co-operative education, work-study and undergraduate nurse employment. Key features, benefits and limitations of each model are discussed. Emerging developments in practice education are increased inter-professional and community-based practice education, and new partnerships among academic and practice organizations. These developments are intended to alleviate model limitations, ease pressures from organizational contexts and respond to large integrated health care systems. Evidence-based research for practice education is beginning to be apparent. Further research is needed that compares models and examines learning, patient care outcomes and costs.

Managerial perceptions of mentor, lecturer practitioner and link tutor roles

Educating pre-registration nurses in clinical practice is a global issue. Within different countries problems exist in educating and supervising students in clinical practice and various models of clinical education are employed. In Wales, United Kingdom, this responsibility is divided between mentors, lecturer practitioners and link tutors. This paper reports on the third phase of a three-phase study in Wales to explore differences between mentors, lecturer practitioners and link tutors, and how they work together to assist students to integrate theory and practice. Four focus group interviews of National Health Service managers and Higher Education managers (n=22) were conducted. Qualitative content analysis revealed four themes: role characteristics and competencies, role differences, role conflict, and future options. The findings suggest a theory-practice continuum along which mentors, lecturer practitioners and link tutors occupy different positions. The article explores these different positions and offers suggestions for future role development.