Supervision training in healthcare: a realist synthesis

Supervision matters: it serves educational, supportive and management functions. Despite a plethora of evidence on the effectiveness of supervision, scant evidence for the impact of supervision training exists. While three previous literature reviews have begun to examine the effectiveness of supervision training, they fail to explore the extent to which supervision training works, for whom, and why. We adopted a realist approach to answer the question: to what extent do supervision training interventions work (or not), for whom and in what circumstances, and why? We conducted a team-based realist synthesis of the supervision training literature focusing on Pawson's five stages: (1) clarifying the scope; (2) determining the search strategy; (3) study selection; (4) data extraction; and (5) data synthesis. We extracted contexts (C), mechanisms (M) and outcomes (O) and CMO configurations from 29 outputs including short (n = 19) and extended-duration (n = 10) supervision training interventions. Irrespective of duration, interventions including mixed pedagogies involving active and/or experiential learning, social learning and protected time served as mechanisms triggering multiple positive supervisor outcomes. Short-duration interventions also led to positive outcomes through mechanisms such as supervisor characteristics, whereas facilitator characteristics was a key mechanism triggering positive and negative outcomes for extended-duration interventions. Disciplinary and organisational contexts were not especially influential. While our realist synthesis builds on previous non-realist literature reviews, our findings extend previous work considerably. Our realist synthesis presents a broader array of outcomes and mechanisms than have been previously identified, and provides novel insights into the causal pathways in which short and extended-duration supervision training interventions produce their effects. Future realist evaluation should explore further any differences between short and extended-duration interventions. Educators are encouraged to prioritize mixed pedagogies, social learning and protected time to maximize the positive supervisor outcomes from training.

Evaluation of Clinical Nursing Practice Programme with Preceptorship Supervision (Stake’s Countenance Evaluation Model)

Introduction: Preceptorship is clinical education for nursing students by conducting constructive partnerships between nurse educators and practitioners. Therefore, the purpose of this study was to find out the effectiveness of the preceptorship programme using the Stake Model Evaluation Programme in terms of aspects antecedents, transactions, outcomes and behaviours.Methods: This study uses descriptive design with quantitative and qualitative approaches. The sample consists of 131 students, 22 clinical preceptors and 22 academic preceptors. The quantitative data were collected using questionnaires, observation and document studies. Qualitative study was conducted using an interview. Descriptive analysis uses mean, standard deviation, percentage, frequency distribution and qualitative analysis using a content analysis.Results: The study evaluation found that at antecedent stage. About 68.2% to 90.9% clinical preceptors had a good preparation on the student preparation stages as perceived by the academic preceptor and preceptee. While in the stage of transaction, preceptors are able to teach nursing care and students to perform nursing care from simple to complex in accordance with the competencies achieved.  Only less than half (45.5%) of students had good implementation of nursing care, including assessment, diagnosis, planning, implementation and evaluation.  However, more than 68% of them showed good professional attitudes and communication. The outcome phase obtained consistency in the result of the practice phase with the national competency test with value from 76.2% to 97.4%.Conclusion: The majority of the antecedent, transaction stage, and outcome showed an average condition which requires an improvement in order to provide a good quality education programme. Future studies may also need to design an alternative approach for students’ supervision in clinic.

Looking beneath the surface of a preceptor-training programme through a realist evaluation

South Africa's department of health devoted themselves to the clinical nursing education and training model, which indorses preceptors as essential stakeholders to promote competence in students. A preceptor-training programme was developed that build on this model and implemented through an intervention. The initial programme theory hypothesised that trained preceptors would promote support and develop competence in students in comparison to untrained preceptors. Results showed a poor outcome because few preceptors participated and a high student attrition rates. The authors then posed the question "Why did the preceptorship training programme not work?" This article offers insight into the context, mechanism, and outcome of the preceptor-training programme through a realist evaluation. Reflective field notes, gathered during the intervention, were used and gave insight regarding how, for whom, and under which circumstances the programme could work and offered a refined programme theory for preceptorship. The main conclusion drawn showed that a preceptor-training programme alone is not the sole determining factor to ensure preceptors' motivation to transfer their learning; a systems approach, ensuring the effectiveness of the programme, should be followed. Reflection on findings indicated the implementation context as a major determining factor of the training programme.

Preceptor Knowledge on Preceptorship in an Academic Hospital in Kenya

BACKGROUND

Clinical preceptorship is critical for the acquisition of knowledge, skills, and attitudes in nursing care. Cardinal to the development of these competences is the preceptor's knowledge on preceptorship. In low-income countries, the responsibility of preceptorship rests with staff nurses whose knowledge on preceptorship is largely unknown.

METHOD

A survey was conducted among 254 nurses using a 3-point Likert scale questionnaire. Mean scale scores were computed for knowledge score. Association between training on preceptorship and level of knowledge was explored using chi square.

RESULTS

The mean knowledge score was 1.71 (SD ± 0.41). Few had undergone training on preceptorship; knowledge on preceptorship had been acquired experientially or through role modeling. More nurses who had undergone training agreed that preceptor-trainee roles should be clearly defined at the beginning of clinical placement, χ²(1) = 15.54, p = .016.

CONCLUSION

Although nurses were knowledgeable about preceptorship, few had been trained. A formal training program on preceptorship is warranted. J Contin Educ Nurs. 2017;48(11):496-500.

The Impact of the Preceptorship Program on Self-efficacy and Learning Outcomes in Nursing Students

Background

This study aimed to determine the impact of the preceptorship program on self-efficacy and learning outcomes and the association between self-efficacy and learning outcomes in nursing students.

Materials and Methods

This quasi-experimental study was conducted on 112 nursing students in 2012-2013. The subjects were selected through convenience sampling from the School of Nursing and Midwifery of Shiraz University of Medical Sciences, Iran. The general self-efficacy scale and the perception of overall learning outcomes scale were used to measure the students' perception of self-efficacy and achievement of learning outcomes. The data were analyzed using Pearson's correlation coefficient and linear regression analysis.

Results

The students' mean [standard deviation (SD)] scores of self-efficacy and learning outcomes were 30.69 (5.88) and 4.10 (0.82), respectively, after taking part in the preceptorship program. The results showed a significant association between the mean scores of self-efficacy and learning outcomes (r = 0.30, p = 0.002). In addition, self-efficacy was predicted by gender (β = -0.19, p = 0.030) and the components of "understand ethical aspects of patient care" (β = 0.31, p = 0.010), "work more systematically" (β = -0.44, p = 0.005), and "use of nursing research" (β = 0.34, p = 0.020).

Conclusions

Although the nursing students who participated in the preceptorship program demonstrated high mean scores of self-efficacy and learning outcomes, the lack of control group led to the conclusion about the effectiveness of the program to be made in caution. However, this program is suggested to be retained in nursing students' curriculum.

The Improvement of Student Competency in a Clinical Study in Indonesia: What Factors Played an Important Role?

Background: The improvement of nursing student competency currently is still being an issue for the majority of nursing education institutions in Indonesia. This is due to partnership with hospitals has not been supported by adequate policies and other factors.Objectives: The purpose of this study was to identify the appropriate model in improving student competency in a clinical study. Design used in this study was observational study with cross-sectional approach.Methods: The research design used cross-sectional approach with involving five hospitals (Fatmawati Jakarta Hospital, Hasan Sadikin Bandung Hospital, Kariadi Semarang Hospital, Sardjito Yogyakarta Hospital, Soetomo Surabaya Hospital) and five universities namely Muhammadiyah Jakarta University, Padjajaran Bandung University, Gadjah Mada Jogjakarta University, Diponegoro Semarang University,  Airlangga Surabaya University. Three hundred and eighty-four participants were recruited from these sites. Data were analyzed  using multiple logistic regression.Results: The result showed that partnership contributed 3,36 times, the patient variations 2,96 times, job description of clinical educator 2,30 times, a role model 2,28 times, expertise of faculty educator  2,08 times, toward the achievement of student competency in clinical study.Conclusions: It can be concluded that partnership aspect, the patient variation, job description of clinical educator, role model, expertise of faculty educator, and level of education have significant role to improve the achievement of student competency in clinical study. The results of this study can be used by nursing educational institutions, hospitals and government to organize nursing education model that has been present for more optimal achievement of student competencies.