Time,fear and transformation: Student nurses’ experiences of doing a practicum (quality improvement project) in practice

BackgroundImproving and sustaining quality in healthcare continues to be a global challenge, resulting in the necessity of developing quality improvement (QI) skills and knowledge to use in practice. This paper reports student nurses’ experiences of conducting a quality improvement project (Practicum) as a compulsory assessment whilst on clinical placement areas across Scotland.MethodsTelephone and face-to-face interviews (n = 18) were conducted using a semi-structured interview schedule. Discussions were transcribed verbatim and data were analysed thematically. Data were extracted from Practicum assignments (n = 50).ResultsThree key themes emerged from the analysis: 1) Time; students highlighted the necessity of time in practice areas to acclimatise, socialise and conduct the Practicum. Timing of the Practicum within the curriculum was also important. 2) Fear; was experienced by many students at the perceived enormity of the assignment, the bravery needed to attempt to change practice and the adjustment to a unique type of assignment. 3) Transformation; students shared their shifted perceptions on completing a Practicum, including a sense of achievement and acknowledgement of key improvement skills for the future.ConclusionsStudent nurses need to be stretched beyond their comfort zones to rise to the challenge of the Practicum, whilst ensuring adequate support mechanisms are in place from a range of sources.     

Student engagement using multiple-attempt ‘Weekly Participation Task’ quizzes with undergraduate nursing students

BackgroundStudent engagement is essential to quality learning. Regular formative assessment tasks can support positive student engagement attitudes and behaviours towards learning.ObjectivesThis study aimed to evaluate the relationships of regular, recurrent delivery of online quizzes in promoting student engagement and academic performance.DesignConcurrent exploratory mixed-method design.SettingA large metropolitan university in Western Sydney.ParticipantsData from 1037 final-year undergraduate nursing students enrolled in a core theoretical unit related to palliative nursing.MethodA series of new Weekly Participation Task (WPT), consisting of multiple online quizzes was embedded into the unit. Administrative data, including data retrieved from the learning analytics, was used for quantitative data analysis. Qualitative data were retrieved from open-ended questions within the institutional Student Feedback on Unit survey.ResultsEach student's overall mean number of attempts was 4.6, achieving a mean quiz score of 97.6%. Students with high quiz attempts were more likely to also had high tutorial attendance (AOR: 1.42, 95% CI: 1.05 to 1.90), achieved maximum quizzes scores (AOR: 1.78, 95% CI: 1.26 to 2.51), but interestingly, lower grade point average (AOR: 1.73, 95% CI: 1.28 to 2.35). The WPT received 111 (26%) positive comments in students' open-ended responses, and all three (behavioural, emotional and cognitive) student engagement dimensions were evident as students' sources of satisfaction.ConclusionsThe WPTs are a successful formative assessment task that supports student engagement across all three dimensions, and contributes significantly to reducing student stress and increasing preparedness for and participation in face-to-face tutorial sessions.     

The implementation of a nursing student clinical assessment tool onto an online platform: An evaluation by clinical facilitators and academic staff

BackgroundFormative and summative assessment plays an integral role in the learning process for undergraduate nursing students on clinical placement.AimEvaluate the integration and implementation of the Australian Nursing standards assessment tool to the online SONIA database.MethodsThe study was designed to evaluate the experiences of clinical facilitators and academic staff using the online platform, which included an online survey and focus group sessions.FindingsWhilst there are benefits gained from using the online system, results highlighted limitations in using technological devices on clinical placement and a lack of education in using the online platform.DiscussionImplementation of a student clinical assessment tool onto an online platform was introduced to counteract the inherent challenges of managing hard-copy assessment data and meet sustainable teaching practices. Participants noted an ease of accessibility to assessment, although issues identified were access to internet in healthcare organisations and lack of education prior to the implementation of the online tool would have supported their experience.ConclusionIntegration of the Australian Nursing Standards Assessment Tool (ANSAT) onto the planet software database brought significant improvements to the access and management of clinical placement assessment information.     

Understanding midwifery student needs and expectations of peer-mentoring for clinical placement: a qualitative questionnaire study

ProblemFirst year undergraduate midwifery students experience significant stress in their early encounters on clinical placement. Peer-mentoring programs may help to address this concern; however, limited attention has been paid to evaluating student needs before implementing peer-led supports for clinical placement.AimThe main objective of this study was to explore first year midwifery students’ experiences of clinical placement in order to understand their needs and expectations from a clinical placement peer-mentoring program.MethodsTwenty-one first year students enrolled in a Bachelor of Midwifery course at a university in Victoria, Australia were involved in the study and completed an online questionnaire with open-ended qualitative responses. Data were analysed using a thematic approach.FindingsThe results indicated that students had varied experiences in the quality of education and support obtained on clinical placement. Many students emphasised a need for greater opportunities for both practical and theoretical learning experiences on placement, and that peer-mentoring had the potential to address these limitations and knowledge gaps.DiscussionSupporting midwifery students on clinical placement is often challenging due to the pressures present in a hospital environment. Peer-mentoring offers a unique and cost-effective means of enhancing support and reducing student anxiety associated with clinical placement.ConclusionPeer-mentoring that is designed to meet student needs is likely to enhance engagement, and thus improve academic outcomes, promote clinical competence, and reduce university attrition rates.     

Teaching evidence-based practice: Case study of an integrated assessment task for diagnostic radiography students

IntroductionA core competency for all health care professionals is evidence-based practice (EBP). An understanding of research skills are key to diagnostic radiographers adopting EBP, and should be taught and assessed in curricula leading to eligibility to register and practice. This paper focuses on the design, implementation and initial evaluation of an assessment task in the Diagnostic Radiography (DR) curriculum at an Australian university, which aimed to facilitate students’ skills to identify and interpret research methods and output as a foundation for EBP by combining with EBP and DR theoretical content.MethodsAn integrated assessment task was introduced across two units of study, requiring student groups to produce a single literature review incorporating learning objectives from each distinct unit of study. This approach recognised and incorporated themes of student choice, negotiation of group membership, and scholarly writing as inherent components.ResultsStudent feedback showed that students valued the integration of content knowledge and research principles across two units of study to better reflect their depth and breadth of learning. Students also commented on the value of team or group work in developing their communication and cooperation skills, which are essential skills in the DR workplace.DiscussionA literature review assessment task integrated across two previously separate units of study provided an innovative approach to assessment of EBP in the DR curricula.ConclusionIt is anticipated that DR graduates, who are prepared with knowledge and skills in EBP prior to graduation, will become leaders and drive future innovation in EBP.     

Flipped versus traditional classroom and student achievement and cognitive engagement in an associate degree nursing fundamental course

BackgroundThere is a call for instructional transformation in nursing education to include an innovative approach. This study aimed to investigate the effects of the flipped classroom method on student achievement and engagement in an associate degree nursing course. This study investigated associate degree nursing studies students’ achievement and cognitive engagement under traditional learning (n = 141) and flipped learning (n = 130). This study was conducted in two first-year cohorts enrolled in their nursing fundamental course, before and during the COVID-19 pandemic respectively at a Hong Kong community college.MethodA mixed methods approach was used with quantitative (examination scores) and qualitative (semi-structured focus group interview) measures applied.ResultsThere was a significant increase in final exam scores for the flipped classroom, all p < 0.01, with a medium-to-large (d = 0.60) effect size. Students commented flipped classroom method promoted their cognitive engagement and the benefits that contributed to such a positive student achievement included more peer interaction and more opportunity to apply their knowledge.ConclusionThis study contributed to our understanding of the effect of the flipped classroom method on student engagement in nursing education.     

Implementing service improvement projects within pre-registration nursing education: A multi-method case study evaluation

BackgroundPreparing healthcare students for quality and service improvement is important internationally. A United Kingdom (UK) initiative aims to embed service improvement in pre-registration education. A UK university implemented service improvement teaching for all nursing students. In addition, the degree pathway students conducted service improvement projects as the basis for their dissertations.AimThe study aimed to evaluate the implementation of service improvement projects within a pre-registration nursing curriculum.MethodA multi-method case study was conducted, using student questionnaires, focus groups with students and academic staff, and observation of action learning sets. Questionnaire data were analysed using SPSS v19. Qualitative data were analysed using Ritchie and Spencer's (1994) Framework Approach.ResultsStudents were very positive about service improvement. The degree students, who conducted service improvement projects in practice, felt more knowledgeable than advanced diploma students. Selecting the project focus was a key issue and students encountered some challenges in practice. Support for student service improvement projects came from action learning sets, placement staff, and academic staff.ConclusionService improvement projects had a positive effect on students' learning. An effective partnership between the university and partner healthcare organisations, and support for students in practice, is essential.     

Cognition and dementia with Raymond and Brain: Curriculum development and evaluation using interactive animated flipped-classroom modules to impact nursing students’ attitude toward dementia care

AimTo design a modular, flipped-classroom curriculum using character animations to improve knowledge and attitudes regarding dementia care among pre-clinical nursing students.BackgroundDemographic trends suggest an urgent, unmet need for nurses with interest and adequate training in caring for people with dementia and other disorders of cognition. While flipped classrooms using video show promise, little is known about specific animation techniques to impact knowledge and attitudes in preclinical nursing education.DesignA curriculum was developed, implemented and assessed across three nursing schools in series, totaling 223 eligible students in the states of Connecticut and Hawaii, USA from 2019 to 2022. The evaluation included prospective pre-post assessment of knowledge, attitudes and module acceptability, as well as qualitative interpretations of needs assessment data.MethodsThe six-step curriculum development process was based on that described by Kern et al., including: 1) general needs assessment in the form of literature review; 2) targeted needs assessment, in the form of faculty stakeholder meetings, a student focus group and baseline surveys; 3) optimization of learning objectives based on needs; 4) development of a pedagogical approach, namely animated, interactive modules informed by previously described best practices in animation development; 5) implementation across three different nursing schools; and 6) assessment of the learners and evaluation of the curriculum, primarily via surveys and engagement metadata.ResultsNeeds assessments confirmed the importance of prior experiences, sense of mission and other affective elements as key factors mitigating learners’ baseline receptiveness to training and careers in cognition-related care. Students at all three institutions rated the modules’ impact on their dementia-related attitudes highly, however these ratings were statistically significantly lower when both modules were delivered as a single assignment at one site. Knowledge quiz scores significantly increased from baseline at all three sites. Only 2.6% of respondents would have preferred a text-based reading assignment. Acceptability scores, including clarity, relevance, entertainment, attention and complexity, were generally rated highly, but attention and entertainment were rated significantly lower when both modules were administered as a single assignment.ConclusionCognition and Dementia with Raymond and Brain demonstrates the successful blending of animation industry workflows with best practices of curriculum development to create a novel, animated module series that is acceptable and effective in priming nursing students with the attitudes and knowledge to continue learning about cognition and its disorders.     

Assessment and communication excellence for safe patient outcomes (ACCELERATE): A stepped-wedge cluster randomised trial protocol

BackgroundNurses play a major role in patient safety. Poor nursing assessment and communication practices are associated with higher incidence of the adverse events of undetected deterioration, falls, and pressure injuries. Despite widespread adoption of patient safety systems, occurrence of these events continues.AimTo implement and evaluate the feasibility and effectiveness of an organisational ward-level intervention to facilitate comprehensive systematic assessment and improved communication in clinical handover to reduce medical emergency team calls; unplanned Intensive Care Unit admissions; falls; and pressure injuries.DesignA stepped-wedge cluster randomised trial sequentially implemented over 12 months.MethodsEvidence-based implementation strategies will be employed to support implementation of an intervention focusing on comprehensive systematic patient assessment and improved nurse bedside clinical handover and multidisciplinary communication involving the patient. These are – intervention tailoring to individual wards through barrier and enabler identification; action plans; education; clinical champions; outreach visits; facilitation; clinician engagement; and reminders. Primary outcome measures will be a composite of Medical Emergency Team calls and unplanned intensive care unit admissions for deterioration. Secondary outcomes will be all categories of inpatient falls; stage 2–4 pressure injuries; nurse-reported perceptions of: teamwork; safety culture, and engagement; and patient-reported experience measures of receiving safe and patient-centred care. An a priori process evaluation will determine factors influencing intervention uptake and inform strategies for future upscale and spread.DiscussionThis feasibility trial will provide evidence regarding the use of systematic comprehensive patient assessment, combined with clinical handover re-design involving patients, to reduce clinical deterioration, falls and pressure injuries.     

Simulated learning environments in speech-language pathology: An Australian response

Abstract

The rising demand for health professionals to service the Australian population is placing pressure on traditional approaches to clinical education in the allied health professions. Existing research suggests that simulated learning environments (SLEs) have the potential to increase student placement capacity while providing quality learning experiences with comparable or superior outcomes to traditional methods. This project investigated the current use of SLEs in Australian speech-language pathology curricula, and the potential future applications of SLEs to the clinical education curricula through an extensive consultative process with stakeholders (all 10 Australian universities offering speech-language pathology programs in 2010, Speech Pathology Australia, members of the speech-language pathology profession, and current student body). Current use of SLEs in speech-language pathology education was found to be limited, with additional resources required to further develop SLEs and maintain their use within the curriculum. Perceived benefits included: students’ increased clinical skills prior to workforce placement, additional exposure to specialized areas of speech-language pathology practice, inter-professional learning, and richer observational experiences for novice students. Stakeholders perceived SLEs to have considerable potential for clinical learning. A nationally endorsed recommendation for SLE development and curricula integration was prepared.     

Restructuring of an evidence-based practice curriculum and assessment with structural mapping by course outcome verb

ObjectiveAn evidence-based clinical practice (EBCP) subcurriculum within a chiropractic curriculum was restructured to distribute EBCP topics to courses throughout the curriculum. We posited that this would enhance student learning through early exposure, repetition, and the use of progressively more difficult levels of learning. In this paper we describe how we determined if Bloom''s verb level trended upward from the beginning of the curriculum to the end and if there were any gaps in presentation of topics periodically in the curriculum. We describe how we determined if the restructured subcurriculum provided adequate integration of topics.MethodsEBCP committee chairs created templates of the new structure, solicited feedback from the faculty, and faculty members volunteered to assimilate topics into courses. Support for the faculty included comprehensive PowerPoint production and in-service training. Assessment for trends and gaps was performed of the resultant learning outcomes by mapping 13 quarters against 6 Bloom''s verb levels for 19 topics.ResultsFourteen of the topics had increasing linear model trends indicating verb progression. Decreased attention to EBCP topics was identified in some quarters.ConclusionThe graphical mapping process seemed useful to find EBCP topics that did not show progression of Bloom''s verb difficulty and gaps in topics in the restructured subcurriculum.     

Alignment of Ethics Curricula in Medical Education: A Student Perspective

Abstract

Issue: Although there is consensus on the importance of including ethics in the medical school curriculum, there is wide variation in how this topic is taught. Recent literature also questions the effectiveness of current ethical teaching methods in changing student attitudes and future behavior. Furthermore, from the student perspective, there is a marked disconnect between the stated importance of and lack of effort in ethics courses. Evidence: Applying a student perspective of the hidden curriculum, as well as reviewing and applying insight from the available literature, we advocate for alignment of instructional design, content, and assessments. This article provides specific recommendations to increase student engagement in ethics courses and concludes by discussing whether a lack of engagement is attributable to intrinsic qualities of medical students in addition to pedagogical technique and educational setting and culture. Implications: This article has practical suggestions for medical educators to improve their ethics courses, leading to more well-rounded and thoughtful physicians.     

Challenges in Translation: Lessons from Using Business Pedagogy to Teach Leadership in Undergraduate Medicine

Problem: Leadership is increasingly recognized as a core physician competency required for quality patient care, continual system improvement, and optimal healthcare team performance. Consequently, integration of leadership into medical school curriculum is becoming a priority. This raises the question of the appropriate context, timing, and pedagogy for conveying this competency to medical students. Intervention: Our program introduced a 1-week leadership course grounded in business pedagogy to Year 1 medical students. The curriculum centred on four themes: (a) Understanding Change, (b) Effective Teamwork, (c) Leading in Patient Safety, and (d) Leadership in Action. Post-curriculum qualitative student feedback was analyzed for insight into student satisfaction and attitude towards the leadership course content. Context: The Undergraduate Medical Education program of the Schulich School of Medicine & Dentistry, Western University, is delivered over 4 years across 2 campuses in London and Windsor, Ontario, Canada. Course structure moved from traditional passive lectures to established business pedagogy, which involves active engagement in modules, case-based discussions, insights from guest speakers, and personal reflection. Outcome: A student-led survey evaluated student opinion regarding the leadership course content. Students valued career development reading materials and insights from guest speakers working in healthcare teams. Students did not relate to messages from speakers in senior healthcare leadership positions. Course scheduling late in the second semester was viewed negatively. Overall student opinion suggested that the 1-week course was suboptimal for establishing leadership principles and translated business pedagogy was ineffective in this context. Lessons Learned: Leadership curriculum in Undergraduate Medical Education should be grounded in a healthcare context relevant to the student's stage of training. Student engagement may be better supported if leadership is framed as a competency throughout their career. Schools considering such innovations could draw lessons from other professional schools and utilize material and faculty that resonate with students.     

Assessing postgraduate outcomes of research-intensive nursing science PhD programs: Methods and metrics

BackgroundAcross disciplines and within higher educational systems, assessing postgraduate outcomes is essential for evaluating doctoral programs, including research-intensive nursing science doctoral programs. However, there are limited reports regarding methods and metrics related to postgraduate longitudinal evaluation of research-focused nursing doctoral programs.PurposeThe purpose of this paper is to summarize studies in the area of postgraduate outcome assessment and provide recommendations regarding outcome methods and metrics for evaluating the effectiveness of research-focused nursing doctoral programs.MethodsPubMed/Medline, CINHAL Complete, and Google Scholar databases were searched using key words including PhD program, doctoral program, longitudinal evaluation, evaluation, program evaluation, PhD alumni survey, education outcomes and PhD program outcomes. We excluded non-English and full-text articles that were not available for review.DiscussionBased on a review of the literature, there are few reports on methods and questionnaires for postgraduate outcome assessment. There is a critical need to develop standardized core metrics/questions, longitudinal assessments, and a shared data repository. The latter will allow for comparisons across nursing doctoral programs.ConclusionRobust standardized longitudinal assessment of nursing doctoral programs is a necessary step for comparison across programs and re-envisioning the nursing doctoral education of the future.     

Student–clinician agreement in clinical competence as a predictor of clinical placement performance in Australian undergraduate physiotherapy students

Objectives: The opportunity for student self-reflection and the accuracy of that reflection are critical to the acquisition of professional competencies. The relationship between student–clinician agreement and clinical performance in physiotherapy students has not yet been investigated. The aim was to determine whether a simple measure of student–clinician agreement assessed midway during a clinical placement predicts final placement score. Participants: 100 undergraduate Monash University Bachelors of Physiotherapy students and their clinical educators. Main outcome measures: Assessment of Physiotherapy Practice (APP). Method: Clinician and student ratings of student performance across all clinical placements from January 2012–June 2013 at two time-points (midway and final) were entered into a purpose-built, web-based platform, and then averaged across the number of placements undertaken. The relationship between midway student–clinician agreement (student minus clinician APP score) and final APP score (determined by the clinician) was analyzed via forward regression. Sub-group comparisons were performed investigating the stability of the relationship across placements. Results: On average, midway agreement was associated with a ?0.50 (95% CI ?0.67 to ?0.33) unit decrease in final placement APP% score. This model was highly statistically significant (p < 0.001) but only explained 24% of the total variance (based on the adjusted r-squared statistic). This relationship was similar in early and late placements. Conclusions: Student–clinician agreement is related to clinical performance. A midway evaluation may provide an important opportunity to identify students “at risk” of poor clinical outcomes enabling timely implementation of support strategies. Further work is required to improve the predictive accuracy of the proposed model.