Strategies for enhancing student learning by managing ambiguities in clinical settings

Have you ever watched as care providers, be they student nurses or staff nurses, display behaviors that seem to indicate that they are becoming overwhelmed by situations in the acute care setting? Have you also observed other providers who seem to thrive on the "challenges" presented by these same situations? The same situation stimulates responses that reflect opposite ends of a continuum, the continuum of tolerance of ambiguity. The nurse educator needs to develop a greater understanding of the elements in the clinical situation (the ambiguities) that have stimulated the behavioral responses, and how an individual's level of tolerance of ambiguity influences reactions to the ambiguous situations. These understandings provide the nurse educator with the foundation for developing teaching strategies to facilitate effective management of ambiguous situations in clinical settings.     

Including children in family-focused acquired brain injury rehabilitation: a national survey of rehabilitation staff practice

OBJECTIVE: To establish whether rehabilitation staff work regularly with child relatives of adults with acquired brain injury to involve them in their family member's rehabilitation. To explore factors influencing rehabilitation staff's decisions about involving child relatives. DESIGN: A cross-sectional postal survey design was used for the main study. Questionnaire packs were sent to rehabilitation staff, followed by a reminder letter one week later. Non-responders received a follow-up pack after three weeks.A prospective design was used with a subsample of participants who re-completed the questionnaire one month later. SUBJECTS: Participants were 393 multidisciplinary staff working in rehabilitation services for adults with acquired brain injury throughout the UK. MAIN MEASURES: A questionnaire based on the theory of planned behaviour was designed specially for the purposes of the study. RESULTS: A response rate of 67% (n=263) was obtained. Few respondents (19%, n=50) reported carrying out work with child relatives. Perceived behavioural control (e.g. access to training, resources and support) significantly predicted staff's intention to work with child relatives, and whether they carried this out. Staff's attitudes towards work with child relatives also significantly predicted intentions. Other influential factors were anxiety, training, work setting and perceptions of colleagues' attitudes. CONCLUSIONS: Little work is carried out with child relatives by acquired brain injury rehabilitation staff, influenced by several factors. A priority in addressing this is to provide staff training.     

Flexible rostering in nursing student clinical placements: A qualitative study of student and staff perceptions of the impact on learning and student experience

AimTo explore whether a flexible rostering system for nursing students during their clinical placements enhanced their experience and contributed to a positive learning environment.BackgroundIn England, attrition from nursing programmes is an enduring issue, often related to student experience of clinical placements. Students juggle caring responsibilities, academic assessment and additional part-time jobs to mitigate financial hardship, while they are undertaking the clinical placement aspect of their courses. Flexible or self-rostering is a system that has been implemented with qualified practitioners in several NHS organisations and may present a solution to the need for flexibility in clinical placements for students.DesignThis was a qualitative pre-and post-intervention study.MethodA flexible rostering system was co-produced with nursing and midwifery students and subsequently implemented in four in-patient areas in an inner-city NHS healthcare organisation between November 2019 and February 2020. Qualitative interview data were collected from participating students and NHS staff from participating clinical areas, before and after implementation between October 2019 and February 2020.ResultsThree focus groups and one interview were undertaken pre-intervention, involving 13 students. Seven students and seven staff participated in a focus group or interviews post implementation. Findings indicated that the flexible rostering system gave students control over their work-life balance and enabled them to feel empowered in their clinical areas, less anxious and more focused on their development. Clinical staff reported unexpected benefits in terms of student attitude and attendance, allowing them to focus on teaching rather than dealing with concerns or changing the rota. Some staff felt there were challenges with implementation, which both students and staff agreed could be addressed by developing rostering guidelines.ConclusionThe findings indicate that wider implementation of the flexible rostering system should be recommended to capitalise on the personal and contextual benefits.     

Reflective practice: a learning tool for student nurses

Reflection is a vital skill in contemporary nursing with student nurses expected to engage in reflective learning from the very beginning of the nurse educational programme. This article demonstrates the meaningful learning that resulted as a consequence of using critical reflection on practice. Gibbs' (1988) cycle aided the process highlighting the practical application of this cyclical framework to the author - a first-year student nurse. Matters concerning gender issues in nursing and professional conduct emerged from the analysis and were inherently explored. The article concludes by demonstrating the personal benefits of using Gibbs' (1988) cycle to varying situations and thus promoting its excellence as a learning tool for student nurses worldwide as a consequence.     

Novices in clinical practice settings: student nurses stories of learning the practice of nursing

Drawing on 24 stories of clinical practice in an apprenticeship context of training in Israel, this qualitative study examined student nurses' perspectives towards learning to become a nurse, as revealed through the language and content of their written stories of clinical practice. As our findings suggest, student nurses' stories of learning to become a nurse in practice settings, are characterized by procedural language, by medical rather than nursing terminology, and by a focus on actions rather than on interactions. We have learned that, despite the rich content that characterizes clinical practice settings, the apprenticeship orientation of the training program, combined with student nurses' state of being a novice, yielded representations of the experience of learning to nurse which were characterized by an instrumental perspective towards the practice. We interpret these findings through four interrelated insights that emerge from the study: (1) an 'instrumental practice' orientation in the setting of caring, (2) knowledge of clinical facts-not knowledge of clinical principles, (3) the fragmented character of novices' learning to nurse in practice, and (4) rich content of practice alone does not yield rich content of learning.     

Developing a learning pathway for student nurses

It is essential to ensure equity and consistency of clinical learning for student nurses who will inevitably work in a variety of practice settings. This article describes the development of a learning pathway in response to the need to improve the quality of learning outcomes in the clinical environment. The North Devon and Exeter model uses a three-step approach, with particular emphasis on the preparation for clinical placements. The model gives equal responsibility to students and clinical staff, promoting a partnership, which takes the student through a quality learning experience. The philosophy that clinical learning should be enjoyable, stimulating and inspirational underpins the structure of the pathway.     

Effectiveness of neurodisability simulation training for NHS staff working in brain injury rehabilitation

Purpose. Members of a regional inter-disciplinary neuro-rehabilitation service took part in simulation exercises aimed at providing insights into the lived experience of those with a neurodisability. The purpose of the study was to evaluate the impact of training on reflective clinical practice.

Method. A sample of 78 professionals working within a UK regional neuro-rehabilitation service took part in neurodisability simulation exercises. Participants were drawn from all healthcare professions represented within the neuro-rehabilitation team. Quantitative and qualitative feedback was collected pre- and post- study and 3 months later. Length of working experience was examined as a possible mediating factor influencing attitudes towards and outcome of simulation training.

Results. Results suggest that participants found the simulation exercise experience insightful and increased their self-reported empathy and concern for those they care for. It also helped inform practical ways of working with patients. Length of staff experience was not found to be a significant factor in attitudes towards or outcome of the training.

Conclusions. Simulation exercises, when organised with the aim of developing insight and empathy can result in positive outcomes for those who take part. Simulation exercises as an integrated learning tool for staff within healthcare settings should be provided.     

Patients' dignity in a rehabilitation ward: ethical challenges for nursing staff

The purpose of this study was to explore the challenges met by nursing staff in a rehabilitation ward. The overall design was qualitative: data were derived from focus interviews with groups of nurses and analyzed from a phenomenological-hermeneutic perspective. The main finding was that challenges emerge on two levels of ethics and rationality: an economic/administrative level and a level of care. An increase in work-load and the changing potential for patient rehabilitation influence the care that nurses can provide in rehabilitating patients, and therefore also affect patients' feelings of self-worth and dignity. Some patients wish to maintain their independence and autonomy, whereas others seem to 'lose themselves'. Independence and autonomy are associated with dignity, but their lack is contrary to it.     

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.     

Self-directed learning and medical rehabilitation: a comparison

A comparison is made between medical rehabilitation and continuing medical education (CME). It is hypothesized that such a comparison can help physicians who have little formal training in educational methodology to become more efficient and effective in carrying out their own self-directed learning. This hypothesis is based on the premise that the decision-making processes are similar for managing the medical rehabilitation of a patient and for carrying out self-directed CME.     

Faculty practice and roles of staff nurses and clinical faculty in nursing student learning.

The perceptions of staff nurses and clinical nurse faculty on the roles they play in nursing student learning were examined. The study also sought to explore how faculty practice status affected these perceived roles. Nursing schools with generic baccalaureate nursing programs in the middle Atlantic region composed the study population. A convenience sample of two schools that expected their undergraduate clinical faculty to engage in faculty practice and two schools that did not expect faculty practice participated in the study. Clinical faculty members (15) and nursing education administrators (4) from each school participated, as well as staff nurses (22) and nursing service administrators (4) from each school's related hospital. Focus groups and individual interviews were conducted. Manifest and latent content analyses were used to examine the issues. Staff nurses who worked with practicing faculty reported fewer instances of role overload, conflict, and ambiguity than when they worked with nonpracticing faculty. Lack of clear communication and delineation of expectations among administrators, staff, faculty, and students were cited as major factors in perceived role problems. Administrators, faculty, and staff nurses viewed high student/faculty ratios as a causative factor in the faculty's inability to meet all teaching objectives with students.     

Falls and fallers in traumatic brain injury (TBI) rehabilitation settings: an integrative review

Abstract

Purpose: To critically appraise the research literature on the nature of falls and fallers in traumatic brain injury (TBI) rehabilitation settings. Method: An integrative review of the literature using thematic analysis was undertaken. Papers identified via a systematic search strategy were independently appraised by two reviewers. A data extraction instrument was developed to record results and to aid identification of themes in the literature. Critical Appraisal Skills Programme instruments were utilised to conduct a methodological critique of the papers included. Results: Thirteen studies were identified as having between 4% and 100% TBI patients in their study cohorts. From these papers, up to 71% of falls took place in a patient’s bedroom occurring in peaks and troughs over a 24-h period. With some divergent results, nine themes were identified describing faller characteristics including: (1) functional mobility impairments; (2) dizziness; (3) bladder and bowel dysfunction; (4) certain medications and number of medications prescribed; (5) executive functioning; (6) patient age; (7) fear of falling; (8) coma length following TBI; and (9) Functional Independence Measure (FIM?) total score, subscale scores and particular individual items. Conclusions: Being a multifactorial phenomenon, falls are a complex clinical issue. Despite the heterogeneity of diagnosis related groups (DRGs) in the included studies, TBI patients were identified as a high falls risk patient population in several studies.

• Implications for Rehabilitation

• Due to multisystem impairments, falls in the traumatic brain injury (TBI) rehabilitation context are a multifactorial and significant clinical issue.

• When interpreting and generalising results from research into falls, clinicians need to be mindful that falls and faller characteristics may be dependent on study setting and patient population.

• There is need for context specific research into faller characteristics following a TBI; particularly in relation to post-traumatic amnesia.

     

Mind mapping: a new tool for enhancing student learning strategy

With the rapid pace of development and reform in education learners face many challenges. Learning how to acquire skills and how to think are very important issues. The application of mind mapping can help students to enhance the creative thinking and problem-solving abilities of the whole brain. In other words, mind-mapping is a visual or pictorial thinking method. This paper introduces the basic concept of mind-mapping, radiant thinking, the methods of mind-mapping, its rules of application, and examples of such application, to improve understanding and knowledge about mind-mapping.     

Mobility activities measurement for outpatient rehabilitation settings

Medina-Mirapeix F, Navarro-Pujalte E, Escolar-Reina P, Montilla-Herrador J, Valera-Garrido JF, Collins SM. Mobility activities measurement for outpatient rehabilitation settings.

Objective

To investigate the factor structure and scale properties of items underlying the mobility activities subdomains of the International Classification of Functioning, Disability and Health (ICF).

Design

A cross-sectional self-report–based psychometric study.

Setting

Outpatient rehabilitation settings (N=3) in 3 urban areas of Spain.

Participants

Convenience sample of 615 patients with musculoskeletal conditions (mean age, 38.1y) participating in an active physiotherapy program.

Interventions

Not applicable.

Main Outcomes Measures

A 22-item Mobility Activities Measure by using a self-report questionnaire that assessed whether patients had limitations on daily activities across major ICF categories of mobility subdomains. Factor analysis, tests of item scaling, internal consistency reliability analysis, Rasch item response theory modeling, and modified parallel analysis were used.

Results

Initial exploratory factor analysis results for each ICF subdomain produced a total of 5 distinct and interpretable factors or dimensions: changing and maintaining body position involving sitting and/or lying; changing and maintaining body position involving standing up; carrying, moving, and handling objects using the hand and shoulder; carrying, moving, and handling objects using the hand and/or forearm; and walking and moving. Dimensionality of these 5 factors was verified by using confirmatory factor analyses and scaling assumptions were met for each dimension. Rasch scaling and modified parallel analysis supported the unidimensionality.

Conclusions

The Mobility Activities Measure is a promising new self-report measure of mobility activities as defined by the ICF. Information about Mobility Activities Measure items and dimensions from this study will be useful in the future operationalization and implementation of ICF.