Preparing nursing students for clinical placement using synchronous role-play telesimulation: A descriptive survey study

BACKGROUND

Contemporary teaching modalities in nurse education include teaching clinical skills via telesimulation. The effectiveness of this modality has not been evaluated.

OBJECTIVE

To evaluate undergraduate nursing students' and clinical facilitators' perceptions of student preparedness for placement when clinical skills are taught via role-play telesimulation using home equipment packs.

DESIGN

A descriptive survey study was employed to measure and explore perceptions using Likert scales and open-structured questions delivered via an anonymous online survey.

SETTING

Clinical placement after undertaking preparation via role-play telesimulation for students at an Australian university.

PARTICIPANTS

Data were collected from 180 undergraduate nursing students and 22 clinical facilitators.

METHODS

Quantitative data were analysed using statistical analysis software, SPPS. Open ended responses to survey questions were analysed through the application of Elo and Kyngas (2008) three phases of content analysis.

RESULTS

Seventy-eight percent of students felt prepared for placement, and 86 % of clinical facilitators believed that students were adequately prepared. Three major categories were identified from students' responses: sense of community, learning logistics, and sense of comfort. Three categories emerged from clinical facilitators' responses: nervous and anxious, confidence and preparedness.

CONCLUSIONS

Findings from this study suggest that role-play telesimulation with home equipment packs is a viable, achievable, sustainable and effective modality for teaching hands-on practical skills to prepare undergraduate nursing students for industry placement.

Pre-assessment judgement framework for judging nursing students' performance in clinical placements: A qualitative case study

AIM

This study aims to better understand and articulate the pre-assessment judgement processes commonly used by experienced clinical facilitators when assessing nursing students undertaking clinical placement.

BACKGROUND

In the Australian context, clinical facilitators are registered nurses who primarily educate, monitor, support and assess groups of nursing students on clinical placements without carrying a patient load. The duties and scope of clinical facilitators may differ across international and institutional contexts. However, the core concepts of this paper will be relevant despite these differences as the importance of facilitators' confidence in making pre-assessment judgements of individual nursing student performance while on placement is universally acknowledged. Nursing students are often assessed on their provision of safe practice, patient task-orientated outcomes and professional behaviour. Clearly articulating performance judgements prior to formal assessment is vital to ensure progressive learning of students. Literature reports that many clinical facilitators lack confidence in the art of making performance judgements and call for targeted professional training and support in the clinical assessment of nursing students. To better understand and address this problem, clinical facilitators need a shared understanding of how individual nursing students' pre-assessment performance judgements are reached during placement experiences.

DESIGN

A qualitative case study was used, with data collected via semi-structured interviews. Fifteen Australian clinical facilitators participated, each with over six months of experience.

METHODS

Interview transcripts were analysed through an interpretive-constructivist paradigm. Thematic analysis revealed themes that were then deductively described through the application of the Cognitive Continuum Theory.

RESULTS

Six modes of pre-assessment judgement emerged from the data synthesis process: 1) Recognising patterns, 2) Acknowledging uncertainty, 3) Understanding key players, 4) Verifying or refuting the information, 5) Benchmarking performance and 6) Contextualising information. Each mode is validated through the deductive application of the Cognitive Continuum theory.

CONCLUSIONS

Understanding how experienced clinical facilitators make pre-assessment performance judgements has the potential to increase confidence in performance judgement decisions. In turn, confidence in judgements will increase clinical facilitator's capacity to give nursing students feedback that can be explained and justified. The pre-assessment judgement framework also provides a preliminary model for teaching the art of reaching accurate performance judgements to clinical educators in disciplines beyond nursing.

Nursing students' development of using physical assessment in clinical rotation-a stimulated recall study

Background

The overall aim of this study was to explore third-year bachelor nursing students’ stimulated recall reflections on their physical assessment competence development. The choice of learning strategies in nursing education seems to have great impact on nursing students’ use of physical assessment skills while in clinical rotation. There is a need to explore nursing students’ learning processes related to the use of physical assessments.

Methods

Explorative qualitative design using a triangulation of data collection methods. Nine final-year nursing students’ physical assessment performances during patient encounters were audio-taped and observed. Shortly after, an individual stimulated recall interview based on the audio-recorded patient encounter and observation notes was conducted. A two-fold analysis was conducted: 1) analysis of students’ performed assessments, and 2) phenomenological hermeneutical analysis of the stimulated recall interviews.

Results

Nursing students assessments shifted from a checklist approach to a symptom-based, more holistic and person-centred approach, emphasizing conversation as part of their assessments. The nursing students also reported that a safe and stimulating learning environment was a prominent feature for their continuing development. Learning from skilled role models with expectations to them using physical assessment skills facilitated their continuing skills appliance, interprofessional communication and reflective practice.

Conclusions

This study contribute with a novel, comprehensive and in-depth description of what influenced nursing students’ learning processes experiences of using physical assessment skills during clinical rotation. The results reveal the need for targeted course designs by implementing scaffolded learning activities in practical and theoretical courses aimed at strengthening students’ learning of physical assessment skills—building upon and emphasizing their prior knowledge and competence, which may lead to more confident registered nurses and promote patient safety in different health care contexts. We propose using stimulated recall systematically as a novel reflective learning activity in nursing education to foster clinical reasoning and metacognition skills and achieve deep learning.

If the public can vaccinate, why not students? Review of a student nurse placement in a mass vaccination centre

Delivery of the COVID-19 vaccine has been made possible in part through the use of mass vaccination centres (MVCs). The primary legal framework underpinning the MVC programme is a national protocol enabling registered and non-registered healthcare workers to contribute to the safe and effective administration of the vaccine. The national protocol provided a vehicle for an innovative supervised student nurse placement within an MVC in south Wales. This placement, for undergraduate pre-registration student nurses, formed part of a service improvement project. Through student feedback prior to, and following, the short placement, the learning was unequivocal in terms of knowledge and skills acquisition related to safe and effective vaccine administration, with students providing clear feedback on the positive nature of the placement experience. A placement within an MVC offers a rich educational experience for student nurses, which as yet appears to be underutilised across the UK.

Community nursing placements: student learning experiences during a pandemic and beyond

This article explores the challenges in maintaining community nursing placements as dynamic learning experiences for student nurses during the pandemic and beyond. Opportunities to create new ways of working and learning are essential to ensure student nurses can continue to be exposed to community nursing care. Developing insight, understanding, knowledge and skills in this unique learning environment is instrumental to encourage the next generation of community nurses and increase the future workforce. Suggestions for alternative ways of providing learning experiences during the present period are discussed, which could also be embedded as long-term strategies in the future.

Effect of a culturally safe student placement on students' understanding of, and confidence with, providing culturally safe podiatry care

BACKGROUND

For university-based podiatry education there are little data available documenting the delivery method and impact of Aboriginal and Torres Strait Islander health curricula or the use of, and outcomes from, immersive clinical placements generally or specific to podiatry practice. Therefore, the primary aim of this study was to evaluate the effect of undertaking clinical placement in a culturally safe podiatry service for Aboriginal and Torres Strait Islander Peoples on podiatry students' understanding of, and confidence with, providing culturally safe podiatry care.

METHODS

Final year University of Newcastle undergraduate podiatry students attending a culturally safe Aboriginal and Torres Strait Islander student clinic at a local hospital were purposively recruited to participate. Students completed a custom-made and pilot-tested cultural awareness and capability survey before and after placement. Survey domains were determined from a principle component analysis. The Wilcoxon Signed Rank test was used to compare pre-placement scores on each domain of the survey to the post-placements scores. Effect sizes were calculated and interpreted as small (0.1-0.29), medium (0.3-0.49), and large (≥0.5).

RESULTS

This study recruited 58 final year University of Newcastle podiatry students to complete baseline and follow-up surveys. For survey domain 1 (level of understanding of power relationships), domain 2 (level of understanding of the interrelationship between culture and self-perceived health), domain 3 (level of understanding of the importance of culture in clinical practice and access to health care), and domain 4 (level of confidence with providing culturally safe care) a statistically significant (p < 0.05) increase in scores was recorded post-placement. The effect sizes were medium to large.

CONCLUSION

This study demonstrated that an immersive student placement at a culturally safe podiatry clinic significantly improved students' understanding of, and confidence with, providing culturally appropriate care to Aboriginal and Torres Strait Islander Peoples. This study provides foundation evidence of the role that such placements have on developing students' cultural capability in a tertiary health care setting, and will help inform future curricula development at both educational institutions and health services, as well as form the basis for ongoing research.

Reflection on actions: Identifying facilitators of and barriers to using physical assessment in clinical practice

Current research suggests that nursing students do not apply all sets of physical assessment skills (PAS) learned in their nursing education. The aim of this study was to evaluate third-year nursing students' process of clinical judgment using PAS in clinical rotation. Specific focus was on how the process of clinical judgment affected when the nursing students performed physical assessment, and which types of knowledge were implied in their practice. Ten nursing students performed PAS independently while in clinical rotation; these performances were audiotaped and observed. Shortly after, individual semi-structured stimulated recall interviews (SRI) took place. Regardless of the nursing students' stated level of PAS utilization, self-efficacy or scientific knowledge, clinical judgment was primarily based on contextual factors and personal prerequisites. This study contributes to in-depth knowledge about how nursing students perform physical assessment, how they describe their clinical judgment process and their strategies towards systematically and confidently using PAS. We conclude the paper with pedagogical strategies and learning activities that can facilitate reflection-in-action and reflection-on-action.

Introducing pharmacy students to the structure and function of general practice through undergraduate placements

BACKGROUND AND PURPOSE

The aim of this study was to design and evaluate the introduction of a sustainable and feasible structure of placements in general practice for third-year pharmacy students at the University of Sunderland. The national agenda in the United Kingdom (UK) calls for an increased presence of pharmacists within general practice; therefore, development of placements in this is setting is aligned to the development of these new roles.

EDUCATIONAL ACTIVITY AND SETTING

The placements were located in general practice surgeries in the North East of England in the UK. Students engaged in activities which introduced them to the structure and function of general practice and familiarise them with the role of pharmacists and other practice staff. Two cohorts undertook the education activity during the development process. The first cohort was comprised of 213 students, with 193 students the following year.

FINDINGS

An action research approach was taken to evaluate and revise the design of the placement. The final design and delivery have been shown to have a positive impact on student learning experience, be feasible and sustainable. The placement was also successful at introducing students to potential future roles in general practice for pharmacists.

SUMMARY

This model of general practice placement provision was found to be a feasible and sustainable delivery model, which was well received by undergraduate students.

Adverse health events associated with clinical placement: A systematic review

OBJECTIVE

Clinical placement is a fundamental aspect of student learning and skill development across healthcare disciplines. However, participation in clinical placements can also present significant risk to students. This systematic literature review sought to examine the range of risks and hazards encountered by students across healthcare disciplines during their clinical placements.

DESIGN

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines were utilised in conducting this exploratory systematic review.

DATA SOURCES

The CINAHL Complete, Medline Complete, and PsycINFO databases were searched. Reference lists of eligible records obtained via database searching were screened, and a supplementary key author search was conducted. Research published between 2013 and 2018 and conducted in the context of comparative international healthcare systems was the focus of this study.

REVIEW METHODS

Study titles and abstracts were screened, and the full text of potentially relevant records was perused. Records meeting key eligibility criteria by addressing risk posed to students in healthcare disciplines within a clinical placement context were included in the final synthesis.

RESULTS

The search identified 46 eligible records. The literature highlighted the worrying trend that students, most notably in the nursing discipline, can be exposed to a wide range of risks and adverse health events during clinical placement.

CONCLUSIONS

As risks in unpredictable clinical environments cannot be eradicated, this review demonstrated a critical need for educative action to enable students to competently and confidently manage risks, and to reduce occurrence of adverse health events.

Potential and challenges for learning during acute medical/surgical placement for intellectual disability, mental health and midwifery students

In Ireland nursing and midwifery degree programmes involve four pathways to registration. Three of which, intellectual disability and mental health nursing and midwifery require students to undertake acute medical/surgical placements offering learning opportunities caring for patients with complex needs in settings beyond their core discipline. This paper focuses on findings from a descriptive qualitative study exploring intellectual disability and mental health nursing and midwifery students experiences of such placements. Data analysis identified three themes: Getting ready, Navigating the way and Getting through. Feelings of stress and uncertainty are described by participants when moving from familiarity within a chosen discipline to an unfamiliar environment. Findings have influenced specific placement structures with local health service partners. While our study focuses on an Irish context, findings have relevance for student education in other jurisdictions. Enhancing preparation and support for students undertaking unfamiliar placements needs to be a constant endeavour. Such foundations will foster valuable experiences where students can feel part of a team, gain confidence, enhance skills and transfer meaningful learning to their core practice discipline. Further research is needed to explore the views of preceptors, ward managers and Clinical Placement Coordinators.

A linear programming approach for placement of applicants to academic programs

This paper reports a linear programming approach for placement of applicants to study programs developed and implemented at the college of Business & Economics, Bahir Dar University, Bahir Dar, Ethiopia. The approach is estimated to significantly streamline the placement decision process at the college by reducing required man hour as well as the time it takes to announce placement decisions. Compared to the previous manual system where only one or two placement criteria were considered, the new approach allows the college’s management to easily incorporate additional placement criteria, if needed. Comparison of our approach against manually constructed placement decisions based on actual data for the 2012/13 academic year suggested that about 93 percent of the placements from our model concur with the actual placement decisions. For the remaining 7 percent of placements, however, the actual placements made by the manual system display inconsistencies of decisions judged against the very criteria intended to guide placement decisions by the college’s program management office. Overall, the new approach proves to be a significant improvement over the manual system in terms of efficiency of the placement process and the quality of placement decisions.